Background and Aims: NAFLD is a leading cause of liver-related morbidity and mortality. We assessed the global and regional prevalence, incidence, and mortality of NAFLD using an in-depth meta-analytic approach. Approach and Results: PubMed and Ovid MEDLINE were searched for NAFLD population-based studies from 1990 to 2019 survey year (last published 2022) per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Meta-analysis was conducted using randomeffects models. Bias risk assessment was per Joanna Briggs Institute. Of 2585 studies reviewed, 92 studies (N = 9,361,716) met eligibility criteria.Across the study period , meta-analytic pooling of NAFLD prevalence estimates and ultrasound-defined NAFLD yielded an overall global prevalence of 30.

Summary Background Mortality benefits of vigorous leisure time physical activity (LTPA) among adults with NAFLD is not known. Aim To investigate association between LTPA and reduction in all‐cause mortality among adults with NAFLD. Methods We used NHANES (1999–2006) self‐reported PA data for adults (≥40 years) with mortality follow‐up through December 31, 2015. US‐Fatty Liver Index in absence of secondary causes identified NAFLD. Moderate and vigorous LTPA were calculated by the 2018 PA Guidelines for Americans. Results NAFLD prevalence among 5211 adults (46.2% male; 75.8% white; mean age 53.2 years) was 32.7%. Adults with NAFLD were less likely to report the recommended minimal PA (≥ 150 min/week, 55.5% vs 64.8%) or highly active PA (≥300 min/week, 39.2% vs 48.5%) compared to adults without NAFLD. Over a median follow‐up of 12.3 years, 355 deaths among adults with NAFLD and 510 deaths among adults without NAFLD were registered. In the metabolic comorbidities‐adjusted model, adults with NAFLD who reported ≥50% of their total PA as vigorous activity had a 56% reduction in all‐cause mortality risk (HR:0.44, 95%CI: 0.25–0.76) and cancer‐specific mortality risk (HR: 0.21, 0.06–0.66) but not cardiac‐specific mortality (p > 0.05) compared to adults with NAFLD who did not report any LTPA. This association remained significant even among adults with NAFLD who met the recommended minimal PA, among adults with NAFLD who reported any LTPA, and among adults with NAFLD who had metabolic abnormalities and in sensitivity analysis. Conclusions Engaging in vigorous activity is beneficial for adults with NAFLD ‐ especially those with metabolic abnormalities.

LINKED CONTENT This article is linked to Henry et al papers. To view these articles, visit https://doi.org/10.1111/apt.17308 and https://doi.org/10.1111/apt.17336